Behavioral science - depression Flashcards
What is needed for DSM5 diagnosis of Major Depressive Disorder?
1) 5 of 9 cardinal symptoms
2) 1 or more needs to be sadness or loss of interest/pleasure
3) persists for two weeks or longer
4) Significantly impacts social functioning
5) can’t be attributable to substances or other med condition
What does SIGECAPS stand for?
S - sleep disturbance I - Interest/pleasure loss G - guilt/worthlessness E - energy loss/fatigue C - concentration/attention disruption A - appetite change S - suicidal ideation
What are the 9 DSM-5 behavioral criteria for major depressive disorder?
i. Decreased mood throughout most of the day, nearly every day – either self reported (sad, empty, hopeless) or observed (e.g. tearful) (In children /adolescents can be irritable)
ii. Diminished interest or pleasure in all or most activities throughout day, most days –either self reported or observed
iii. Loss or gain of 5% body weight within one month without dieting, or decrease in appetite
(Children may not reach expected weight gain)
iv. Insomnia or hypersomnia
v. Psychomotor agitation or retardation
vi. Fatigue or loss of energy
vii. Feelings of worthlessness or excessive guilt
viii. Diminished ability to think or concentrate, indecisiveness
ix. Recurrent thoughts of death of suicidal ideation
5/9 needed for 2 weeks, distress + social disturbance, cant be attributable to something else, need i or ii to be included in 5/9
What is SWAG? What is it used for?
Suicidlal, Weight change (5%), Anhedonia, Guilt
Used to differentiate sadness from depression
What is atypical depression?
depression marked by weight gain and hypersomnia
what is pseudo demnentia?
cognitive symptoms in depressed elderly often misdiagnosed as “dementia”
What is characteristic pattern of diurnal variation in major depressive disorder?
worse in AM than PM
What are characteristic psychomotor symptoms in major depressive disorder?
body aches, headaches, aggitation or retardation, vegetative depression
What is SAD? What are the treatments?
full-spectrum light exposure, psychotherapy , antidepressants
Are depressive symptoms in SAD typical or atypical?
Atypical - weight gain, hypersomnia
What type of patients exhibit masked depression?
elderly patients, obsessivecompulsive/
narcisstic personalities
What would bring masked depression patient to primary care doc?
psycho motor or somatic symptoms instead of typical depressive symptoms (SIGECA_S)
How do masked depression patients usually present clinically?
vague physical ailments but unaware/in denial of their depression
– stoic with psychomotor complaints
What are 6 medical causes of depressive syndromes that would exclude patients from DSM-V diagnosis of major depressive disorder?
• Hypothyroidism • Cushing’s Syndrome • Anemia • Brain injury, stroke • Vitamin deficiency (B12, Folate, Vit D) • Obstructive sleep apnea…
• Hypothyroidism • Cushing’s Syndrome • Anemia • Brain injury, stroke • Vitamin deficiency (B12, Folate, Vit D) • Obstructive sleep apnea…
can cause ______ and should be included in differential Dx for _______
medically induced depressive syndromes that would exclude DSM-V diagnosis of major depressive disorder
What are 4 biological factors implicated in major depressive disorder?
– Monoamine Deficiency • ↓levels of Dopamine (DA), Serotonin (SR), Norepinephrine (NE) – Monoamine Receptor excess – Loss of neurotrophic factors – Genetics • Serotonin transporter gene
Do monoamine receptors increase or decrease in major depressive disorder?
increase
Which neurotransmitter are implicated as biological causes of depression?
↓levels of Dopamine
(DA), Serotonin (SR),
Norepinephrine (NE)
Name 10 environmental risk factors for major depressive disorder
CRAAAPLLIS
– Catastrophic loss – Resilience – Ability to cope with life stressors – Addiction – Anger turned inward? – Personality traits – Learned helplessness – Low self esteem, negative outlook – Incapacity via hibernating? – Social disconnect?
Which gene has been implicated as a biological cause of major depressive disorder?
• Serotonin transporter gene
What is probably a good indicator of depression based on neurotransmitter biology?
Ratio of monoamine receptors to transmitters
High # of receptors and/or low # of transmitter = Depression
Are genetics or environmental factors bigger contributors to depression?
Environmental factors
65% vs 35% genetics
What can be used to determine relative role of biology vs environment in depression?
twin studies
Does having had prior episodes of depression increase or decrease likelyhood of having more episodes?
increases
How can stress influence depression on a molecular level?
stress increases glucocorticoids which decrease brain derived neurotrophic factor (BDNF)
Decreased BDNF leads to debranching of dendrites and neuronal atrophy/death
What brain regions are dysfunctional in depression?
Dorsolateral prefrontal cortex (DLPFC) and amygdala
In depression what happens to the Dorsolateral prefrontal cortex and amygdala?
Dorsolateral prefrontal cortex becomes hypoactive
amygdala becomes hyperactive
Aside from growth factors, neurotransmitters and neurotransmitter receptors, what might be an additional cause of depression?
dysfunctional neurocircuitry a connectivity
Is depression more common in Men or women?
Women
What are two big co-morbidities of depression?
substance abuse and general anxiety disorder
Do black people get depressed as much as white people?
no
What are the front line antidepressants?
Why are they preferred over other drugs?
- Selective SR Reuptake Inhibitors (SSRI)
- Selective NE, SR Reuptake Inhibitors (SNRI)
NE, DA Reuptake inhibitors (NDRI)
less side effects
What can be used as adjunctive treatment alongside antidepressants?
– Lithium
– Thyroid hormone
– Atypical antipsychotic
What is different about sedating antidepressants (e.g. trazadone and mirtazapine) from front line antidepressants?
Block 5HT2 receptors and H1 receptors instead of using SSRI mechanism
What is the MOA of Mirtazapine?
A2A antagonist - blocks presynaptic NE autor-receptor activation resulting in an increase of NE (disinhibition)
blockade of which seratonin receptor is thought to cause sedation?
5HT7 (I think)… but chart is fucked up
What are the two fastest acting anti-depressant drugs?
psychostimulants and ketamine IV
What are the indications for use of electroconvulsive therapy?
– Effective for severe depression, especially if nonresponsive
to meds
– Used when antidepressants cannot be used due to
toxicity/side effects, or when antidepressants fail
– Also used when immediate resolution of symptoms is
needed (i.e. patient is acutely suicidal or psychotic)
What role might functional brain studies have in treatment of depression?
assessment of response to treatment
What causes major depressive disorder?
– Monamine deficiency – Monoamine Receptor Excess Theory – Neurotrophic Neurodegenerative Hypothesis – Psychosocial factors – coping mechanisms, catastrophic loss
What are the treatments for major depressive disorder?
– SSRIs (1st line), SNRIs, NDRIs,
MAOIs, TCAs
– Talk therapy
– ECT, TMS, DBS, etc
A patient with autoimmune disease must take cortisol pills daily at high dose. Which of the following might explain why depression is more likely to occur in this patient? A. Increasing cortisol increases serotonin B. Increasing cortisol decreases norepinephrine receptors C. Increasing cortisol decreases brain neurotrophic factors
C
A 48 year old woman is in the midst of her 4th depression. Which statement is the most accurate?
A. She will likely remit from this depression
and have them less often given her age
and gender
B. She will likely get depressed more
quickly even when her stress levels are
low from now on
C. She will likely be less depressed as she
has learned how to cope with her
depression over the years
B
A 28 year old depressive’s chief complaint is poor
cognition and erratic sleep schedule. What 5HT receptor
would you most like to manipulate to help this patient?
A. Agonize 5HT3
B. Antagonize 5HT1a
C. Antagonize 5HT7
D. Agonize 5HT2
C - I think…
